Anxiety in Perimenopause: When That Feeling of Dread Could Be Hormonal

Over the last few years, working with women going through perimenopause and menopause, there is one symptom that comes up again and again, and that's anxiety. 

Women tell me they suddenly feel more worried, overwhelmed or on edge. Some describe a feeling of dread that seems to appear from nowhere. Others tell me they simply don't feel like themselves anymore.  I've also spoken to women who have sought medical help for their anxiety and have been offered medication, without anyone discussing the possibility that their changing hormones could be contributing to how they are feeling. And this is something I feel we need to talk about much more.

Anxiety is a recognised symptom of perimenopause and menopause. In fact, for some women, changes in mood, anxiety and sleep can appear relatively early in the menopausal transition. 

Sometimes the missing piece of the puzzle is simply understanding why you suddenly feel this way.

When Anxiety Doesn't Seem to Have a Reason

There is an important distinction to make here. Anxiety during perimenopause is very real. It should never be dismissed as "just hormones", and we shouldn't assume that every woman experiencing anxiety in her 40s or 50s has it because of menopause. Anxiety disorders, depression, chronic stress and difficult life circumstances can all occur during this stage of life and deserve appropriate support and treatment.

However, hormonal changes during perimenopause can also trigger new anxiety or make existing anxiety worse. This can be particularly confusing for a woman who has never previously considered herself an anxious person. You might wake up feeling that something is wrong, even though you can't identify what it is. You may suddenly worry about things that previously wouldn't have bothered you. Your heart might race. You might feel restless, tense or unable to switch your thoughts off. Your confidence may change. You may find yourself overthinking situations that you would once have dealt with easily. And sometimes there really isn't an obvious external reason for it.

Why Can Perimenopause Make Us Feel Anxious?

During perimenopause, our hormones don't simply decline smoothly. They can fluctuate considerably. Oestrogen and progesterone interact with systems in the brain involved in mood, sleep and our response to stress. As hormone levels change, some women become much more vulnerable to changes in mood and anxiety.

Progesterone is particularly interesting because one of its metabolites, allopregnanolone, interacts with GABA receptors in the brain. GABA is one of the brain's main inhibitory neurotransmitters and plays an important role in helping us feel calm.

Oestrogen also has complex effects on brain signalling, including systems involving serotonin and other neurotransmitters associated with mood.

So when hormones fluctuate during perimenopause, the effects aren't limited to our periods, body temperature or reproductive system. Our brains feel those changes too. This is one of the reasons anxiety can seemingly appear from nowhere during this stage of life.

I Know That Feeling of Dread Myself

This is something I can relate to personally. I'm now in the later stages of perimenopause and although I use body-identical hormone replacement therapy, exercise regularly, eat right and do all the right things - most of the time, every so often, I still have a morning when I wake up with that feeling. The best word I can use to describe it is dread.

I wake up and immediately feel anxious, as though there is something I should be worried about. Sometimes it almost takes my breath away. My mind then naturally starts looking for the reason. “What am I anxious about?” And yes, there are usually plenty of things going on in my life! However, when I actually stop and think about it, I realise there isn't necessarily anything happening that warrants the intensity of the feeling I'm experiencing.

I've also learnt that lying in bed thinking about it is one of the worst things I can do. For me, getting up and starting my day helps enormously, and most importantly, I now recognise the feeling for what it is. Instead of immediately believing every anxious thought my brain produces, I can remind myself that my hormones may be contributing to how I'm feeling today and it will pass. That understanding alone can take away some of its power and give the power back to you.

Knowing What Is Happening Can Make a Difference

I think this is one of the most important messages we can give women. Understanding that hormonal changes may be contributing to your anxiety doesn't magically make the feeling disappear, but it can change how you respond to it.

When you don't understand what is happening, the feeling itself can become frightening.

Why do I feel like this? What's wrong with me? Why can't I cope anymore? Why am I suddenly worrying about everything?

Those thoughts create another layer of anxiety.

Once you understand that perimenopause can affect the way your brain regulates mood and stress, you can begin to separate the feeling of anxiety from the belief that there must necessarily be something terrible to worry about. Sometimes your nervous system is sounding an alarm even though there is no immediate danger.

Anxiety and Sleep: A Difficult Combination

Sleep is another huge part of the picture. Sleep disturbances are extremely common during the menopausal transition, and anxiety and poor sleep can quickly begin feeding into one another.

Hormonal changes, hot flushes, night sweats and other menopausal symptoms may disturb sleep.

Anxiety can make it difficult to fall asleep or return to sleep after waking. Then, after a poor night's sleep, we are tired and have less emotional resilience the following day. Everything can feel harder and we worry more easily, and then of course we become anxious about whether we are going to sleep that night. It can become a vicious cycle.

This is why improving sleep is often an important part of supporting a woman who is experiencing anxiety during perimenopause.

What Can Help?

There isn't one solution that will be right for every woman. For some women, HRT can make a significant difference. HRT is an established treatment for menopausal symptoms, including menopause-associated anxiety and low mood, and it can also improve sleep and other symptoms that may be contributing to anxiety.

HRT isn't appropriate or wanted by everyone, however, and treatment should always be individualised and discussed with an appropriately qualified healthcare professional.

CBT and other psychological therapies can also be extremely helpful. Medication for anxiety or depression may, of course, be appropriate for some women, particularly when there is an underlying anxiety disorder or depression. However, medication doesn't necessarily need to be the only avenue explored. When anxiety has appeared during the menopausal transition, it is important to look at the wider picture and consider whether hormonal changes may be contributing.

There are many other ways we can support our emotional wellbeing and nervous system during this time. These may include hormone therapy where appropriate, CBT, counselling or psychotherapy, regular exercise, improving sleep, breathwork, relaxation techniques and finding practical ways to manage stress and support nervous system regulation.

Ultimately, the aim should be to understand what may be contributing to the anxiety and find the combination of support that is right for the individual woman, rather than assuming that there is one solution that will work for everyone.

And then there are the everyday foundations that can make a surprisingly significant difference.

Look After Your Sleep

Prioritise sleep as much as possible. Try to keep reasonably consistent sleeping and waking times and create a bedroom environment that supports sleep. If you wake and find yourself lying there becoming increasingly anxious, sometimes getting up for a while and doing something quiet can be more helpful than remaining in bed fighting with your thoughts.

Move Your Body

Regular physical activity is one of the tools I recommend most often. Walking, strength training, yoga, running, swimming or whatever form of movement you enjoy can support mood, sleep and stress management. Keep in consistent.

Don't Forget Nutrition

What we eat cannot prevent every episode of anxiety, but nutrition provides the raw materials our nervous system needs to function normally. Aim for a varied, predominantly whole-food diet containing plenty of vegetables and fruit, good-quality protein, wholegrains, legumes, nuts and seeds, healthy fats and omega 3 rich foods.

Nutrients such as magnesium, B vitamins, zinc and omega 3 fatty acids all have roles within normal neurological and psychological function.

It is also worth paying attention to caffeine and alcohol. Some women find that they become much more sensitive to either during perimenopause and that reducing them helps with anxiety, palpitations and sleep.

Give Your Nervous System Time to Slow Down

We spend so much time rushing from one thing to another that sometimes we forget that our nervous system needs periods of calm too.

Our autonomic nervous system has two important branches: the sympathetic nervous system, associated with our ‘fight or flight’ response, and the parasympathetic nervous system, often described as our ‘rest and digest’ system. The sympathetic nervous system is essential when we need to respond to stress or a perceived threat, but we don't want to feel as though we are constantly stuck in this heightened state of alert.

Making time for activities that help us slow down can support a shift towards greater parasympathetic activity, allowing the body to move into a calmer state. Yoga, meditation, slow breathing exercises, walking outdoors, gardening, reading, spending time in nature or simply sitting quietly for ten minutes can all provide opportunities to slow down and give our minds and bodies a break from the constant stimulation of everyday life.

Find something that genuinely works for you. We are all different, and what helps one woman to unwind and feel calmer may not necessarily work for you. The important thing is finding something that allows your mind and body to slow down.

Recently one of my closest friends told me that she simply couldn't meditate. Sitting still just didn't work for her - her mind would immediately start racing with a hundred different thoughts, but she found peace when walking her dogs through the park. That's when she relaxes, switches off and feels completely at ease. That's her meditation.

At the end of the day, it's about finding what works for you and what gives your nervous system that opportunity to slow down.

Talk About It

One of the most powerful things about women talking openly about menopause is the realisation that so many of us are experiencing similar things. Talk to your partner, your friends and, most importantly, talk to other women.

And if anxiety is persistent, severe or interfering with your everyday life, speak to an appropriately qualified healthcare professional.

You Are Not Imagining It

If you have reached your 40s or 50s and suddenly find yourself thinking "Why have I become so anxious?", consider whether perimenopause could be part of the picture, particularly if you have also noticed changes to your menstrual cycle, sleep, mood, temperature regulation or other menopausal symptoms.

Anxiety is a recognised symptom of the menopausal transition.

For me, simply being able to recognise those occasional mornings of dread for what they are has changed the way I deal with them. I don't lie there searching for something to worry about. I get up, I start my day, I remind myself that a feeling is not necessarily evidence that something is wrong, and usually, it passes.

Sometimes understanding what is happening inside our bodies is one of the most powerful tools we have.

If you are struggling with symptoms during perimenopause or menopause and would like personalised nutrition and lifestyle support, please feel free to get in touch - healingwithStephie@gmail.com